Healthcare Provider Details

I. General information

NPI: 1740034404
Provider Name (Legal Business Name): TASHONDA FERGUSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 MAIN AVE
CLIFTON NJ
07011-2333
US

IV. Provider business mailing address

51 YALE AVE
IRVINGTON NJ
07111-2230
US

V. Phone/Fax

Practice location:
  • Phone: 201-344-2499
  • Fax:
Mailing address:
  • Phone: 484-456-0894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: